Provider Demographics
NPI:1699924282
Name:RIEDER, MATTHEW A (DPT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:A
Last Name:RIEDER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 3RD ST
Mailing Address - Street 2:SUITE202
Mailing Address - City:NEPTUNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32266-5072
Mailing Address - Country:US
Mailing Address - Phone:904-249-5020
Mailing Address - Fax:904-241-7777
Practice Address - Street 1:700 3RD ST
Practice Address - Street 2:SUITE202
Practice Address - City:NEPTUNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32266-5072
Practice Address - Country:US
Practice Address - Phone:904-249-5020
Practice Address - Fax:904-241-7777
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist